Methods, Systems, And Devices For Joint To Pump Elevation Level User Interfaces, Autocalibration For Joint Elevation, And Joint Pressure Estimation

ABSTRACT

Various exemplary methods, systems, and devices for joint to pump elevation level user interfaces, autocalibration for joint elevation, and joint pressure estimation are provided. In general, an arthroscopic pump can be configured to estimate fluid pressure at a surgical site, e.g., at a joint, to provide an accurate indication of fluid pressure to users. In an exemplary embodiment, the fluid pressure estimation is based on a fluid pressure measurement at the pump that is adjusted at the pump, e.g., by a processor at the pump that executes instructions stored in a memory at the pump, using one or more control algorithms that adjust for one or more factors, such as pressure loss in tubing and sheath through which fluid flows between the pump and the surgical site and elevation difference between the pump and the surgical site.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application claims priority to U.S. Provisional PatentApplication No. 62/553,397 entitled “Methods, Systems, And Devices ForJoint To Pump Elevation Level User Interfaces, Autocalibration For JointElevation, And Joint Pressure Estimation” filed Sep. 1, 2017, which ishereby incorporated by reference in its entirety.

FIELD

The present disclosure relates generally to methods, systems, anddevices for joint to pump elevation level user interfaces,autocalibration for joint elevation, and joint pressure estimation.

BACKGROUND

Arthroscopic pumps are used in a variety of surgical procedures inconnection with a variety of functions, such as soft tissue ablation,contouring, cutting, coagulation, and temperature control. Duringperformance of a surgical procedure an arthroscopic pump may provideirrigation (inflow) of fluid to a surgical site, e.g., a joint of apatient, and aspiration (outflow) of fluid from the surgical site. Thepump may control fluid pressure at the joint to help provide jointdistension for easy access, maintain good visibility, and/or to controlbleeding. However, it is difficult for the pump to have an accuratemeasure of fluid pressure at the joint and, thus, for the pump toaccurately control fluid pressure within the joint. For example,arthroscopic pumps typically do not measure fluid pressure at the jointbut instead measure fluid pressure at the pump and make adjustments tothe pump pressure to estimate fluid pressure at the joint. However, ifthe pump and the patient's joint are at different elevations, such as ifthe pump is on a cart at a higher elevation than the patient on anoperating table, the fluid pressure measured at the pump will notaccurately reflect the fluid pressure at the joint. Additionally, fluidtravels between the pump and the joint through tubing and the sheath,but pumps may not accurately account for pressure loss in the tubing andsheath as the flow varies through the pump. Further, although anarthroscopic pump may provide an indication of measured fluid pressureat the pump, the pump does not indicate to surgeons that the measuredfluid pressure is at the pump, not the joint, which may cause thesurgeon to inappropriately control fluid pressure to be too high or toolow at the joint since the information being provided to the surgeondoes not accurately reflect actual fluid pressure at the joint.

In some systems, fluid pressure may be measured at the joint, such aswith sensors positioned at the joint, but measuring fluid pressure atthe joint and communicating the measured fluid pressure to the pumptypically results in a significant cost increase for the disposabletube-set, which is not feasible for most hospitals and surgeons.

Accordingly, there remains a need for improved devices, systems, andmethods for arthroscopic pumps.

SUMMARY

In general, methods, systems, and devices for joint to pump elevationlevel user interfaces, methods, systems, and devices for autocalibrationfor joint elevation, and methods, systems, and devices for jointpressure estimation are provided.

In one aspect, a surgical system is provided that in one embodimentincludes a fluid pump system including a fluid pump. The fluid pumpsystem is configured to pump fluid between the fluid pump and a surgicalsite through tubing, measure a pressure of fluid at the fluid pump,determine an estimated pressure of fluid at the surgical site byadjusting the measured pressure based on at least one of an elevationdifference between the fluid pump and the surgical site and a type ofthe tubing, and provide an indication of the estimated pressure of fluidat the surgical site to a user of the fluid pump.

The surgical system can vary in any number of ways. For example, thefluid pump system can be configured to provide the indication of theestimated pressure by displaying the estimated pressure on a display ofthe fluid pump system. For another example, the fluid pump system can beconfigured to measure the pressure of the fluid at the fluid pump bysensing a pressure of fluid within a fluid chamber at the fluid pump.

For yet another example, the fluid pump system can be configured toreceive an input from a user of the fluid pump indicative of theelevation difference. In at least some embodiments the fluid pump systemcan be configured to automatically prompt the user to provide the inputupon startup of the fluid pump, and/or the fluid pump system can beconfigured to provide a visual indication of the elevation difference ona display at the pump.

For still another example, a processor of the fluid pump system can beconfigured to automatically determine the elevation difference. In atleast some embodiments the processor can be configured to automaticallydetermine the elevation difference upon startup of the fluid pump.

For another example, the fluid pump system can be configured to receivean input from a user of the fluid pump indicative of the tubing. For yetanother example, the fluid pump system can be configured to determinethe estimated pressure of fluid at the surgical site based on the typeof the tubing as determined by measuring pressure based on a speed of anirrigation motor at the fluid pump. For another example, the fluid pumpsystem can be configured to determine the estimated pressure of fluid atthe surgical site also based on a type of sheath associated with thetubing as determined by measuring pressure based on a speed of anirrigation motor at the pump. For still another example, the fluid pumpcan be an arthroscopic fluid pump. For yet another example, the surgicalsite can be a joint of a patient. For another example, the fluid pumpsystem can include a sensor configured to measure the pressure of thefluid at the fluid pump, and the fluid pump system can include aprocessor configured to receive the measured pressure from the sensor,determine the estimated pressure, and cause the indication to beprovided to the user. For yet another example, the fluid pump caninclude a memory having an algorithm stored therein, and the fluid pumpcan include a processor configured to execute the algorithm and therebycause the processor to determine the estimated pressure.

For another example, determining the estimated pressure can includeestimating loss at an inflow to the surgical site. In at least someembodiments, estimating loss at the inflow can include determining aspeed of a motor of the fluid pump.

In another aspect, a surgical method is provided that in one embodimentincludes pumping fluid between a fluid pump system and a surgical sitethrough tubing, measuring a pressure of fluid at a fluid pump of thefluid pump system, determining an estimated pressure of fluid at thesurgical site by adjusting the measured pressure based on at least oneof an elevation difference between the fluid pump and the surgical siteand a type of the tubing, and providing an indication of the estimatedpressure of fluid at the surgical site to a user of the fluid pump.

The surgical method can have any number of variations. For example,providing the indication of the estimated pressure can includedisplaying the estimated pressure on a display of the fluid pump system.For another example, measuring the pressure of the fluid at the fluidpump can include sensing a pressure of fluid within a fluid chamber atthe fluid pump.

For yet another example, the method can include receiving at the fluidpump system an input from a user of the fluid pump indicative of theelevation difference. In at least some embodiments the method can alsoinclude the fluid pump of the fluid pump system automatically promptingthe user to provide the input upon startup of the fluid pump, and/or theinput can change a visual representation of relative elevation levels ofthe fluid pump compared to the surgical site by changing a relativeposition of an icon representative of a fill chamber of the fluid pumpand an icon representative of the surgical site.

For another example, the method can include a processor of the fluidpump system automatically determining the elevation difference. In atleast some embodiments the fluid pump system automatically determinesthe elevation difference upon startup of the fluid pump.

For yet another example, the method can include receiving an input froma user of the fluid pump indicative of the tubing. For another example,determining the estimated pressure of fluid at the surgical site basedon the type of the tubing can include determining the measured pressurebased on a speed of an irrigation motor at the fluid pump. For stillanother example, the fluid pump can be an arthroscopic fluid pump. Foranother example, the surgical site can be a joint of a patient. For yetanother example, the fluid pump system can include a sensor thatmeasures the pressure of the fluid at the fluid pump, and the fluid pumpsystem can include a processor that receives the measured pressure fromthe sensor, determines the estimated pressure, and causes the indicationto be provided to the user. For yet another example, the fluid pumpsystem can include a memory having an algorithm stored therein, and thefluid pump system can include a processor configured to execute thealgorithm and thereby cause the determining of the estimated pressure.

For another example, determining the estimated pressure can includeestimating loss at an inflow to the surgical site. In at least someembodiments, estimating loss at the inflow can include determining aspeed of a motor of the fluid pump.

BRIEF DESCRIPTION OF DRAWINGS

This invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1 is a perspective view of one embodiment of an arthroscopic fluidpump;

FIG. 1A is a block diagram of the pump of FIG. 1 operatively coupled toa surgical site via inflow tubing, sheath, and outflow tubing;

FIG. 2 is a display of the fluid pump of FIG. 1 showing one elevationdifference between the fluid pump and a patient;

FIG. 3 is the display of the fluid pump of FIG. 1 showing anotherelevation difference between the fluid pump and a patient;

FIG. 4 is the display of the fluid pump of FIG. 1 showing yet anotherelevation difference between the fluid pump and a patient;

FIG. 5 is a block diagram showing one embodiment of a fluid controlalgorithm of the pump of FIG. 1;

FIG. 6 is a graph showing fluid pressure versus time;

FIG. 7 is still another graph showing fluid pressure versus time;

FIG. 8 is another graph showing fluid pressure versus time; and

FIG. 9 is a graph showing fluid pressure at three different fluid flowrates.

DETAILED DESCRIPTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices, systems, and methods disclosedherein. One or more examples of these embodiments are illustrated in theaccompanying drawings. Those skilled in the art will understand that thedevices, systems, and methods specifically described herein andillustrated in the accompanying drawings are non-limiting exemplaryembodiments and that the scope of the present invention is definedsolely by the claims. The features illustrated or described inconnection with one exemplary embodiment may be combined with thefeatures of other embodiments. Such modifications and variations areintended to be included within the scope of the present invention.

Further, in the present disclosure, like-named components of theembodiments generally have similar features, and thus within aparticular embodiment each feature of each like-named component is notnecessarily fully elaborated upon. Additionally, to the extent thatlinear or circular dimensions are used in the description of thedisclosed systems, devices, and methods, such dimensions are notintended to limit the types of shapes that can be used in conjunctionwith such systems, devices, and methods. A person skilled in the artwill recognize that an equivalent to such linear and circular dimensionscan easily be determined for any geometric shape. Sizes and shapes ofthe systems and devices, and the components thereof, can depend at leaston the anatomy of the subject in which the systems and devices will beused, the size and shape of components with which the systems anddevices will be used, and the methods and procedures in which thesystems and devices will be used.

Various exemplary methods, systems, and devices for joint to pumpelevation level user interfaces, methods, systems, and devices forautocalibration for joint elevation, and methods, systems, and devicesfor joint pressure estimation are provided. In general, an arthroscopicpump can be configured to estimate fluid pressure at a surgical site,e.g., at a joint, to provide an accurate indication of fluid pressure tousers (e.g., surgeons and other medical personnel). Fluid pressure atthe surgical site may therefore be accurately controlled to improvesurgical outcomes. The fluid pressure at the surgical site can beaccurately controlled even when an external flow device is inserted intothe joint. Being able to accurately control actual joint pressure to beless than 60 mmHg may help reduce risk to the patient during thesurgical procedure, such as by reducing risk of extravasation due topressure being too high. In an exemplary embodiment, the fluid pressureestimation is based on a fluid pressure measurement at the pump that isadjusted at the pump, e.g., by a processor at the pump that executesinstructions stored in a memory at the pump, using one or more controlalgorithms that adjust for one or more factors. One of the factors thatcan be used in estimating fluid pressure is pressure loss in tubingthrough which fluid flows between the pump and the surgical site.Another one of the factors that can be used in estimating fluid pressureis elevation difference between the pump and the surgical site.Expensive and specialized equipment, such as tubing having built-inpressure sensors, is therefore not needed to measure fluid pressure atthe surgical site itself. In other words, an accurate estimation offluid pressure at the surgical site can be determined even with fluidpressure being measured only at the pump.

Estimating losses, e.g., tubing losses and sheath losses, may allow forcontrol of surgical site pressure by and adding them to a surgical sitepressure set-point, e.g., a joint pressure set-point, to update the pumppressure set-point in a pump pressure control loop, which may beexecuted quickly. The control loop may therefore provide faster responseand more stability than direct control of surgical site pressure.

In certain surgical setups a pump may have an elevation difference withthe surgical site of six inches or more. In some cases the elevationdifference can be multiple feet, such as when the pump is positioned ona cart or shelf above or below the level of the patient on an operatingtable. Although the pump's instructions for use (IFU) may cautionagainst such pump positioning relative to the patient, the IFU may notalways be followed, such as due to space constraints in the operatingroom or due to fixed cart height. In general, elevation differencesbetween the surgical site and pump result in an error of 22.4 mmHg perfoot of elevation difference. In other words, the fluid pressuremeasured at the pump will not accurately reflect the fluid pressure atthe surgical site when the surgical site and the pump are at differentelevations, with the discrepancy between the fluid pressures beingincreasingly greater for larger elevation differences. The ability tocompensate for elevation difference and provide an accurate estimationof fluid pressure at the surgical site may greatly reduce error.

FIGS. 1 and 1A illustrate one embodiment of a pump system including anarthroscopic pump 10 configured to estimate fluid pressure at a surgicalsite 100. In an exemplary embodiment the surgical site is at a jointsuch as the knee or shoulder. The pump 10 is configured to estimate thefluid pressure at the surgical site 100 in real time with performance ofthe surgical procedure based on at least one of elevation differencebetween the pump 10 and the surgical site 100 and tubing through whichfluid flows between the pump 10 and the surgical site 100. In anexemplary embodiment the pump 10 is configured to estimate pressurebased on each of these two factors, although pressure may be estimatedusing only one of these factors. Each of the inflow tubing 102 and theoutflow tubing 104 have an associated sheath, in which case the fluidpressure can be estimated based on the tubing 102 and its associatedsheath.

The pump 10 can have a variety of configurations. In the illustratedembodiment the pump 10 includes an irrigation pump configured to pumpfluid to the surgical site and includes an aspiration pump configured topump fluid from the surgical site. The pump 10 includes joint inflowtubing to allow fluid to flow between the pump 10 and the surgical site.FIG. 1A schematically illustrates the pump 10 operatively connected tothe surgical site 100 via the inflow tubing 102 and illustrates outflowtubing 104 which returns to an aspiration pump of the pump system andthen to a waste reservoir. The pump 10 also includes a fill chamber orreservoir 12 which is used to smooth the fluid flow and to providepressure sensing with the sensing tube at the top of the reservoir 12.Pressure is sensed at the fluid level, e.g., water level, in the chamber12 so the fluid level is the effective pressure sensor location.

The pump system also includes a processor 22 that is configured tocontrol the irrigation pump 10 and the aspiration pump. The pump 10 isconfigured to measure fluid pressure at the pump 10 based on fluidpressure within the reservoir 12 and on pump motor speed, e.g., a speedof a motor 24 configured to drive the pump 10. The pump 10 is configuredto adjust the pressure measured at the pump 10, as controlled by theprocessor 22, to determine estimated pressure at the surgical site 100using one or more control algorithms, as discussed further below. Theone or more control algorithms are stored in a memory 26 of the pumpsystem and are executable by the processor 22. The processor 22 and thememory 26 are shown as part of the pump 10 in FIG. 1A, but in otherembodiments the processor 22 and/or the memory 26 can be locatedelsewhere in the pump system.

The pump system also includes a user interface configured to facilitateuser interaction with the pump 10. The user interface includes a firstdisplay 14 configured to display joint pressure (in mmHg in thisillustrated embodiment) in real time with use of the pump 10 duringperformance of a surgical procedure. The fluid pressure shown on thefirst display 14 is the estimated pressure of fluid at the surgicalsite. The user interface also includes a second display 16 configured todisplay shaver speed (in revolutions per minute (RPM) in thisillustrated embodiment).

The user interface also includes user controls configured to receiveinput from the user to control various pump functions. In theillustrated embodiment the user controls include depressible +/−(up/down) arrow buttons to control adjustment of information on thefirst display 14, and depressible +/− (up/down) arrow buttons to controladjustment of information on the second display 16. In other embodimentscontrols other than buttons may be used for one or both of the displays14, 16, such as knobs, dials, levers, a keypad, or the like. Aspirationpump flow rates are controlled by buttons labelled FLOW+ and SHAVER. TheFLOW+ flow button is configured to be activated with a foot pedal, andthe SHAVER flow button is configured to be activated when a shaver isenabled. The illustrated embodiment also includes a key that enablesfilling of the fill chamber 12 and a key that enables SOLO (irrigationpump only) mode. In other embodiments one or both of the FLOW+ andSHAVER buttons can have another form, such knobs, dials, levers, or thelike. The illustrated user interface also includes lights, e.g.,light-emitting diodes (LEDs) or the like, that illuminate to indicatevarious conditions such as bloodstop, high pressure warning, lowpressure alarm, FLOW+ flow rate, SHAVER flow rate, chamber fill enabled,and pump on/off (run/stop).

As mentioned above, the pump 10 can be configured to estimate pressureby taking into consideration the elevation difference between the pump10 and the surgical site 100. The user interface in the illustratedembodiment is configured to facilitate the pump's compensation forelevation differences between the pump 10 and the surgical site 100.

The first display 14 is configured to show thereon an elevation iconindicating relative elevation of the pump 10 and the patient. Theelevation icon in this illustrated embodiment is InternationalOrganization for Standardization (ISO) compliant. As shown in FIG. 1,the elevation icon includes a pump fill chamber icon 18 in the form of apump fill chamber with a fill level and an ISO approved patient icon 20in the form of a patient on an operating table, although other forms ofelevation icons can be used. The fill level is indicative of the levelwhere pressure is being sensed. For example, the fill chamber icon inFIG. 1 shows the fill chamber partially filled, and it is this filllevel that indicates the level where pump pressure is sensed, e.g., thezero-elevation level. The elevation difference between the pump 10 andthe surgical site 100 is defined with respect to the zero-levelelevation, with the surgical site 100 either being at the zero-levelelevation (e.g., no elevation difference), below the zero-levelelevation, or above the zero-level elevation.

The second display 16 is configured to show the elevation differencebetween the pump 10, e.g., the fill level of the fill chamber 12, andthe surgical site 100 at the patient. The patient icon 20 on the seconddisplay 16 is configured to be in one of three positions relative to thepump fill chamber icon 18 to indicate whether the surgical site 100 iselevated above the fill chamber 12 (patient icon 20 in an upperposition), the surgical site 100 is at a same elevation as the fillchamber 12 (patient icon 20 in a middle or neutral position), or thesurgical site 100 is lower than the fill chamber 12 (patient icon 20 ina lower position). In the illustrated embodiment, as shown in FIG. 1,the second display 16 shows the elevation difference between the filllevel of the fill chamber 12 and the surgical site 100 as being −5 cm,indicating that the surgical site 100 is 5 cm lower than the pump 10.The patient icon 20 is thus in a lower position relative to the pumpfill chamber icon 18 on the first display 14. In other embodiments, moregranular positions of the patient icon 20 may be used by having morethan three possible positions of the patient icon 20 relative to thepump fill chamber icon 18. For example, five positions may be possiblefor the patient icon 20 relative to the pump fill chamber icon 18: aposition indicating that the surgical site 100 is at a same elevation asthe fill chamber 12, a first higher position indicating an elevationabove a first predetermined threshold elevation difference, a secondhigher position indicating an elevation above a second predeterminedthreshold elevation difference that is greater than the firstpredetermined threshold elevation difference, a first lower positionindicating an elevation lower than a third predetermined thresholdelevation difference, and a second lower position indicating anelevation lower than a fourth predetermined threshold elevationdifference that is greater than the third predetermined thresholdelevation difference.

The user interface is configured to allow a user to adjust the elevationdifference using the +/− arrows associated with the first display 14 or,alternatively, the +/− arrows associated with the second display 16. Forexample, each push of the + arrow can increase the elevation differenceby a predetermined amount, e.g., 1 cm, 2 cm, 5 cm, 10 cm, etc., and eachpush of the − arrow can decrease the elevation difference by apredetermined amount, e.g., 1 cm, 2 cm, 5 cm, 10 cm, etc. As theelevation difference is adjusted, the patient icon 20 moves up/downaccordingly to provide visual indication of the patient's elevationrelative to the pump 10, and in particular relative to the fluid levelin the fill chamber 12 of the pump 10. A positive, non-zero elevationdifference indicative of the fill level of the fill chamber 12 beingabove the surgical site 100 can be shown with the patient icon 20 anupper position relative to the pump fill chamber icon 18 on the firstdisplay 14, and in particular relative to the fluid level mark on thepump fill chamber icon 18. For example, FIG. 2 shows an elevationdifference of +10 cm on the second display 16 and the patient icon 20thus in the upper position. A zero elevation difference can be shownwith the patient icon 20 a middle or neutral position relative to thepump fill chamber icon 18 on the first display 14, and in particularrelative to the fluid level mark on the pump fill chamber icon 18. Forexample, FIG. 3 shows an elevation difference of 0 cm on the seconddisplay 16 and the patient icon 20 thus in the middle or neutralposition. A negative, non-zero elevation difference indicative of thefill level of the fill chamber 12 being below the surgical site 100 canbe shown with the patient icon 20 a lower position relative to the pumpfill chamber icon 18 on the first display 14, and in particular relativeto the fluid level mark on the pump fill chamber icon 18. For example,FIG. 4 shows an elevation difference of −10 cm on the second display 16and the patient icon 20 thus in the lower position. Elevation differencemay be higher than +10 cm or less than −10 cm. For example, elevationdifference may be in a range from −60 cm to +90 cm.

The user interface is configured to show the elevation icon on the firstdisplay 14 upon startup of the pump 10. For example, when power isturned on or when the run/stop button is pushed to signal pump “on,” theuser is prompted by instruction on one or both of the displays 14, 16and/or by audible instruction through a speaker operatively connected tothe pump 10 to confirm relative elevation of the surgical site 100 andpump 10, in particular the fill level of the pump's chamber 12. The userconfirms the relative elevation by adjusting elevation as needed usingthe +/− arrows associated with the first display 14. The system may thushave accurate relative elevation information that the processor 22 canlater use in estimating fluid pressure at the surgical site 100. Toaccept the displayed elevation as accurate, the user presses therun/stop button. After the user's manual input of the relativeelevation, the first display 14 can continue displaying the elevationicon or can instead display a numerical value of fluid pressure, and thesecond display 16 can continue displaying elevation level or can insteaddisplay a numerical value of shaver speed. Another press of the run/stopbutton starts the irrigation pump and the aspiration pump.

In at least some embodiments, a measurement device can be provided thatis configured to facilitate the user's input of elevation difference tothe pump 10. For example, the pump 10 can have a mechanical measurementdevice mounted thereon, e.g., a ruler or the like, that a user canextend from the pump 10 to the surgical site 100 to allow measurement ofsurgical site elevation using line of sight. The mechanical measurementdevice mounted to the pump 10 can be retractable (similar to a tapemeasure) to facilitate storage and/or ease of use. For another example,the pump 10 can have a mechanical measurement device mounted thereon asdescribed above in addition to a level laser light source to facilitatemeasurement of surgical site elevation. The level laser light source canbe located, for example, at the end of the mechanical measurementdevice. For yet another example, a mechanical measurement device can bemounted on a cart on which the pump 10 sits and can be extended from thecart to the surgical site to allow measurement of surgical siteelevation using line of sight. The mechanical measurement device mountedto the cart can be retractable (similar to a tape measure) to facilitatestorage and/or ease of use. For still another example, the pump 10 canhave a slide mounted thereon that has a linear encoder (magnetic oroptical) mounted thereon. The slide can be selectively movable up anddown by a user to align an end of the slide with the surgical site 100using line of sight, with the linear encoder measuring position. Foranother example, the pump 10 can have a slide as described above inaddition to a level laser light source to facilitate measurement ofsurgical site elevation. The slide can be selectively movable up anddown by a user to align a light beam (e.g., from the light source suchas a laser point) with the surgical site 100, with the linear encodermeasuring position. For yet another example, the pump 10 can include alaser interferometer configured to measure elevation difference betweenthe pump 10 and the surgical site 100.

In at least some embodiments, rather than a user manually inputelevation difference between the pump 10 and the surgical site 100, thepump 10 is configured to automatically determine elevation distancebetween the pump 10 and the surgical site 100. In such an embodiment,the pump 10 is configured to automatically determine elevation onstartup of the pump 10 so the pump 10 has the relevant informationneeded to adjust fluid pressure in view of the elevation difference whenthe pump 10 is in use. In general, to automatically determine elevationthe pump 10 can be configured to zero the pressure at the level of thesurgical site 100 to allow for compensation of any elevation differencebetween the surgical site 100 and the pump 10.

In one embodiment of pump autocalibration, at pump startup, the userwill press the run/stop button on the pump's user interface. An iconwill then show on the first display 14 and/or the second display 16indicating that a pressure calibration will occur. The user will holdthe sheath connected to the end of the irrigation tubing 102 that runsbetween the pump 10 and the surgical site 100 at the level of thesurgical site 100, e.g., at joint level, with the pump's irrigationvalve open and then press the run/stop button for the second time. Thepump 10 can be configured to prompt the user to hold the sheath at thelevel of the surgical site 100, such as by instruction on one or both ofthe displays 14, 16 and/or by audible instruction through a speakeroperatively connected to the pump 10. The pump's irrigation pump willthen function in flow control mode for sufficient time for it to prime.At this time, the pressure will be recorded for a predetermined amountof time, e.g., a few tenths of a second, and averaged. Then theirrigation flow will be increased to provide another pressure datapoint. These two pressure versus flow data points will be used by thepump 10, e.g., a processor 22 thereof, in a control algorithm toestimate the elevation of the surgical site 100 relative to the pump 10as well at the losses in the tubing and sheath. The results of thealgorithm will then be limit checked by the pump 10, e.g., by theprocessor 22 thereof, and if the results are within a predeterminedtolerance, the pump 10 will end the autocalibration. The end ofautocalibration may be indicated by the pump 10, such as with audiblesound such as a beep and/or with a visual on one or both of the displays14, 16. At the end of autocalibration, depressing the run/stop buttonwill allow the user to adjust the joint pressure set-point and shaverRPM speed set-point. Another press of the run/stop button will start thepump 10 in its normal pressure regulation mode.

As mentioned above, in addition to or instead of the pump 10 estimatingpressure by taking into consideration the elevation difference betweenthe pump 10 and the surgical site 100, the pump 10 can be configured toestimate pressure by taking into consideration the tubing 102, 104 and,if present, the sheaths associated with the tubing 102, 104. In at leastsome embodiments the pump 10 can be configured to allow a user to inputtubing size and/or sheath size. The pump 10 can be configured to use theinput size in evaluating pressure loss compensation due to the tubingand sheath that runs between the pump 10 and the surgical site 100. Forexample, the pump's user interface can include a depressible sheath sizecontrol button that allows the user to use the +/− arrows associatedwith the first display 14 or the second display 16 to adjust sheath sizeup/down to reflect the current sheath size. Depressing the sheath sizecontrol button again can indicate acceptance of the displayed sheathsize. In general, although high flow sheaths are used in mostarthroscopic surgeries, smaller low flow sheaths are typically used forsmall joints and result in reduced accuracy in joint pressures. Thus,allowing input of sheath size will allow the pump 10 to compensate forsheath size in estimating fluid pressure at the surgical site. In otherembodiments a control other than a button may be used for inputtingsheath size, such as knobs, dials, levers, a keypad, or the like. Inaddition to or instead of a depressible sheath size control button, thepump's user interface can include a depressible tubing size controlbutton that allows the user to use the +/− arrows associated with thefirst display 14 or the second display 16 to adjust tubing size up/downto reflect the current tubing size similar to that discussed aboveregarding the input of sheath size. In other embodiments a control otherthan a button may be used for inputting tubing size, such as knobs,dials, levers, a keypad, or the like.

One embodiment of a control algorithm that the pump system can use toestimate and control fluid pressure based on at least tubing loss andsheath loss is described below with respect to FIG. 5. In an exemplaryembodiment, as shown in FIG. 5, the control algorithm is implemented ina combination of software and hardware. The processor 22 is configuredto execute the control algorithm using various electronic components, aswill be appreciated by a person skilled in the art, such as pumpcomponents of a rotary encoder, motor/gearbox, pressure transducer, andinterface/control circuits.

The algorithm first determines a pump pressure set-point by estimatingtubing/sheath losses and adding this pressure drop to the joint pressureset-point. A pump pressure control loop is then controlled using aproportional plus integral (PI) controller. Additionally, feedforwardcontrol from the suction pump is applied to anticipate sudden flowchanges induced by the aspiration pump, such as flow+ and shaver flows.The pressure control signal (from the PI controller) combined with thefeedforward signal from the suction pump provide a velocity command toan irrigation velocity control loop. FIG. 5 illustrates the irrigationpump control loop. The pump pressure set-point is updated based on theestimated losses in the tubing and sheath. The estimation algorithm isupdated on a regular basis as opposed to only when changing flow mode.The regular basis can be any of a variety of predetermined intervalsduring use of the pump system, such as every X seconds, every Y minutes,etc.

The irrigation pump is configured to control the pressure at thesurgical site, e.g., in the surgical joint where arthroscopic surgery isbeing performed. However, pressure is not measured at the joint but onlyat the pump, e.g., in the fill chamber. So, to regulate joint pressure,tubing/sheath losses are estimated and then added to the desired jointpressure P_(joint) _(_) _(cmd), e.g., the pressure set-point previouslyinput to the pump and/or as preset at the pump, to provide the updatedpump pressure set-point P_(pump) _(_) _(cmd). The basis for addingdesired joint pressure to tubing/sheath loss to produce the updated pumppressure set-point is that the pump pressure is equal to the jointpressure plus the tubing/sheath pressure drop. The tubing/sheath lossesare a function of flow and are therefore a function of a speed of thepump system's irrigation motor. The algorithm therefore takes motorspeed w into account to estimate fluid pressure at the surgical site,e.g., at the joint. The estimator for tubing/sheath loss is as follows,where ω=angular velocity of irrigation motor in EncoderCnts/sec:

Tube/Sheath Loss [mmHg]=4.70*ω²+0.0091*ω+10

Angular velocity is calculated by using the irrigation encoder interruptto determine time between successive encoder pulses (identical to thesuction pump velocity calculation). Velocity in encoder counts persecond is determined as follows:

Velocity=1406250 [clkPulses/sec]/time between Encoder pulses

When the timer interrupt has not occurred for 5 milliseconds (10 timesthrough 2 KHz timer interrupt), the velocity will be reported as zero.The velocity command is updated on a regular basis as the output of thepressure loop PI (Proportional, Integral) controller used for pressureregulation. The regular basis can be any of a variety of predeterminedintervals during use of the pump system, such as every X seconds, everyY minutes, etc. The pressure control system uses the same velocitycontrol strategy as for the suction pump, so the pressure controller(PI) provides a velocity command to the velocity control loop and thisupdate is used in the controller calculations. The pressure loop PIcontroller is updated in the 2 KHz timer interrupt which is also usedfor control of the suction pump and the shaver. However, the pressurecontrol algorithm is only updated every 64 times through the ISR(interrupt service routine) which is equal to 32 msec. This issufficient due to the low closed loop bandwidth of the pressure controlloop (i.e., <2 Hz). The PI controller equations are as follows, whereKp=400, Ki=0.222, Kd=0.0, suctionFeedForward=suction speed*efficiencyratio of irrigation/suction pump:

setPointPumpPress=setPointJointPress+TubeSheathLoss

Pcontrol=error*K+SUM_ERROR*Ki−Kd*dErr

VELCMD=Pcontrol+suctionFeedForward

To determine the updated pump pressure set-point, the above equation isexecuted on a regular predetermine basis, e.g., every 32 msec, however,the TubeSheathLoss is only updated when the pump pressure has settled:If successive readings (spaced at, e.g., 500 msec) are within, e.g., 2mmHg of each other.

A control loop is used for regulating the angular velocity of thesuction (aspiration) pump. While both current and velocity feedback canbe used, current feedback is not required. The controller outputprovides a PWM duty cycle to the motor using a 20 KHz PWM output comparetimer. Additionally, a rate limit is provided to the PWM outputs so thatpulses are ramped at each transition to eliminate the pulsing of themotor at 2 KHz which would certainly be audible. The rate limit is 10encoderCnts/2 KHz interrupt. This means that the motor can go from zeroto max speed within 0.8 seconds.

To improve response time to shaver or Flow+ step changes in suctionflow, a motor velocity feedforward term is provided from the suctionmotor speed command. This helps the joint pressure control loop toanticipate local (i.e., caused by this pump) flow disturbances such asenabling or disabling the shaver or flow+. Suction speed feedforward ismultiplied by the pump efficiency ratio to provide the correct steadystate feedforward flow compensation in the irrigation pump to offset theadditional flow in the suction pump. A ramp is applied to the suctionfeedforward speed to try to offset the speed ramp in the suction pumpused for shaver and Flow+ flows. Feedforward suction speed compensationis combined with the output of the PID controller to provide a velocitycommand to the velocity control loop used for the irrigation pump. Thisvelocity control loop is identical to the suction pump.

To prevent annoyance of rapid updates of the joint pressure displayed,the pressure displayed is the estimated joint pressure updated everyhalf second and additional filtering. The factory default joint pressuresetting is 70 mmHg, although the default can be updated by the user withthe default menu. In other implementations, the factory default pressuresetting is 50 mmHg.

Suction pump operation only requires the user to press the RUN button,as long as SOLO mode is not selected and a door of the pump system isclosed. This is assuming that no faults exist such an over-current forthe pump motors.

The irrigation (inflow) pump control uses a 2 KHz timer and two separatecontrol mechanisms pressure (two pressure sensors) and velocity (highspeed encoder) to control the motor speed. FIG. 5 shows the overallcontrol loop for regulating the pressure.

When the pump is in RUN mode, the 2 KHz loop along with the state-chartprocessing below performs the following: (1) The pressure controlleruses the readings from two analog channels (ADC) to determine thedifference between the pressure set-point and the actual pressure readat the pressure sensors. These signals are read and averaged together.Based on this difference (error) the new command PWM duty cycle countsvalue that is fed into the velocity portion of the motor control loop isdetermined; and (2) the velocity controller uses the feedback from thehigh-speed encoder (frequency) which is tied to an Input Capture CompareTimer. Using the command counts determined in the previous step and thespeed frequency of the motor a new duty cycle to the PWM command inputis calculated. This command is then fed into the PWM control registerassociated with the Inflow motor. The PWM frequency is, e.g., 20 Khz.The two pressure signals are monitored and compared to ensure that theyare accurate within a predetermined threshold, e.g., +/−10%, from eachother.

FIGS. 6-8 are graphs showing various scenarios in which fluid pressureat the pump, e.g., pressure measured at the fill level of the pump'sfill chamber, differs from fluid pressure at the surgical site. Theseillustrated differences between pressure at the pump and pressure at thesurgical site help highlight the importance of estimating pressure atthe surgical site instead of considering pressure measured at the pumpto be an accurate reflection of pressure at the surgical site.

FIG. 6 is a graph showing pressure (in mmHg) versus time (in tenths of asecond) in response to a 30 mmHg step (70 mmHg to 100 mmHg) for pressureat the fluid pump and estimated pressure at the surgical site (which isa joint in this embodiment) calculated by the fluid pump withcompensation for elevation and tubing/sheath losses. The graph showsthat the pressure at the fluid pump differs only slightly from theestimated pressure at the surgical site.

FIG. 7 is a graph showing pressure (in mmHg) versus time (in tenths of asecond) in response to a step change in flow of about 350 mL/min due toan internal shaver suction source active from about 5 sec to about 250sec. The graph shows that the pressure at the fluid pump increases asflow increases in order to regulate joint pressure while the shaver isenabled.

FIG. 8 is a graph showing pressure (in mmHg) versus time (in tenths of asecond) in response to a step change in flow of about 350 mL/min due toan external suction source active from about 5 sec to about 25 sec. Thegraph shows that the pressure at the fluid pump increases to regulatethe pressure at the surgical site.

FIG. 9 is a graph demonstrating the effectiveness of controlling fluidpressure at the surgical site using the fluid pressure estimation thatis described herein. The graph of FIG. 9 shows pressure (in mmHg) atthree different fluid flow rates: idle flow, medium flow, and high flow.The graph shows that by estimating fluid pressure at the surgical siteas described herein, the fluid pressure at the surgical site can beaccurately controlled to allow surgeons to use a lower pressureset-point, which may help improve patient safety, e.g., help reduce therisk of extravasation or otherwise help improve patient safety, bymaintaining fluid pressure at a safe level. The pressure set-point inthis example is 50 mmHg, and the site pressure in this example is 47mmHg at idle flow, 49 mmHg at medium flow, and 43 mmHg at high flow,which is very good pressure regulation over such a flow range.

A person skilled in the art will appreciate that the present inventionhas application in conventional minimally-invasive and open surgicalinstrumentation as well application in robotic-assisted surgery.

One skilled in the art will appreciate further features and advantagesof the invention based on the above-described embodiments. Accordingly,the invention is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Allpublications and references cited herein are expressly incorporatedherein by reference in their entirety.

1. A surgical system, comprising: a fluid pump system including a fluidpump, the fluid pump system being configured to: pump fluid between thefluid pump and a surgical site through tubing, measure a pressure offluid at the fluid pump, determine an estimated pressure of fluid at thesurgical site by adjusting the measured pressure based on at least oneof an elevation difference between the fluid pump and the surgical siteand a type of the tubing, and provide an indication of the estimatedpressure of fluid at the surgical site to a user of the fluid pump. 2.The system of claim 1, wherein the fluid pump system is configured toprovide the indication of the estimated pressure by displaying theestimated pressure on a display of the fluid pump system.
 3. The systemof claim 1, wherein the fluid pump system is configured to measure thepressure of the fluid at the fluid pump by sensing a pressure of fluidwithin a fluid chamber at the fluid pump.
 4. The system of claim 1,wherein the fluid pump system is configured to receive an input from auser of the fluid pump indicative of the elevation difference.
 5. Thesystem of claim 4, wherein the fluid pump system is configured toautomatically prompt the user to provide the input upon startup of thefluid pump.
 6. The system of claim 4, wherein the fluid pump system isconfigured to provide a visual indication of the elevation difference ona display at the fluid pump.
 7. The system of claim 1, wherein aprocessor of the fluid pump system is configured to automaticallydetermine the elevation difference.
 8. The system of claim 7, whereinthe processor is configured to automatically determine the elevationdifference upon startup of the fluid pump.
 9. The system of claim 1,wherein the fluid pump system is configured to receive an input from auser of the fluid pump indicative of the tubing.
 10. The system of claim1, wherein the fluid pump system is configured to determine theestimated pressure of fluid at the surgical site based on the type ofthe tubing as determined by measuring pressure based on a speed of anirrigation motor at the fluid pump.
 11. The system of claim 1, whereinthe fluid pump system is configured to determine the estimated pressureof fluid at the surgical site also based on a type of sheath associatedwith the tubing as determined by measuring pressure based on a speed ofan irrigation motor at the pump.
 12. The system of claim 1, wherein thefluid pump is an arthroscopic fluid pump.
 13. The system of claim 1,wherein the surgical site is a joint of a patient.
 14. The system ofclaim 1, wherein the fluid pump system includes a sensor configured tomeasure the pressure of the fluid at the fluid pump, and the fluid pumpsystem includes a processor configured to receive the measured pressurefrom the sensor, determine the estimated pressure, and cause theindication to be provided to the user.
 15. The system of claim 1,wherein the fluid pump system includes a memory having an algorithmstored therein, and the fluid pump system includes a processorconfigured to execute the algorithm and thereby cause the processor todetermine the estimated pressure.
 16. The system of claim 1, whereindetermining the estimated pressure includes estimating loss at an inflowto the surgical site.
 17. The system of claim 16, wherein estimatingloss at the inflow includes determining a speed of a motor of the fluidpump.
 18. A surgical method, comprising: pumping fluid between a fluidpump system and a surgical site through tubing; measuring a pressure offluid at a fluid pump of the fluid pump system; determining an estimatedpressure of fluid at the surgical site by adjusting the measuredpressure based on at least one of an elevation difference between thefluid pump and the surgical site and a type of the tubing; and providingan indication of the estimated pressure of fluid at the surgical site toa user of the fluid pump.
 19. The method of claim 18, wherein providingthe indication of the estimated pressure includes displaying theestimated pressure on a display of the fluid pump system.
 20. The methodof claim 18, wherein measuring the pressure of the fluid at the fluidpump includes sensing a pressure of fluid within a fluid chamber at thefluid pump. 21-33. (canceled)